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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
835i 0 BMC :z/,11"D?
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--Date{ # + r ?` Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt -from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Sianature of Owner _
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(Q) - I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier a 1'ATr 1•'LMD Policy No. }.Itlil t$?-f9i
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(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section -3700 of the Labor
Code, I shall forthwith comply with those provisions,/'
Date: "'A -Applicant"-1
Warning: Failure to secure: Workiars'Compensation coveragiis unlawful and J
shall subject an employer to criminal'penalties and civil fines up to $ �ig9,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Buildin SatYl
for a permit subject to the conditions and restrictions set forth ,op—his—
application. CITY(
1. Each person upon whose behalf this application is made & ea , persDD_'RNE
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees:
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection -purposes.
Signature (Owner/Agen )�- ' " Date
BUIL'DING
PERMIT-" .M7-2,5;
DATE VALUATION �x+ LOT TRACT
JOB SITE
ADDRESS �,Z ?.� �.a33r6JYYlu` 6X ,s
APN Y
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OWNER
CONTRACTOR / DESIGNER / EN &NEER
CC.,AR-M EwX ERMSES
NICHOLAS DEM A'.EW
22) X .ALIM RO 13LLVD 0 9348
78-120 CAUX. FZFPMO
121' RRSIDE C. 925115
LAQUINTA CA 92253
(760)?'x'1.8220 CBV# 3224
USE OF PERMIT
P001, AlTDIOR VA
P003APA..FYLARkliWlfl.F.RAUERS MALL BiMI PLACE A.T PRF PL r,c?T'E P_ '
INSP1, 01 OK �..4 UI;5MEWT EMC IRE NOT INCLIFM
VALUATION 140190.00 LS
E IAM COR' OF COVCIU=N
1510WAXI
y ryp7XYE St/MpaRS
PLAN MCK FELT 101.000«439.318 S105,Irv,
C0 1S'F RUCTIOM FrRR 101-000-419-000 $162.0
MECHANICAL ' L FEZi - POC )L 101.000-421-0019 SA -00
M,WTI IC,9 L FRE • POOL, 101—, PO0420-l; 00 $45.110
PLt1MUT90 RE - �bm 101'900-419-000 S27,0D
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FLAQUINTA
NCEDEPT'lYY'.€X.C"X11,MI TRUCTAO:9AbMP'3...AXC1rHIM
RECEIPT
DATE
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DATE FINA ED
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IN$PE TO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
�2--
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
7 _02—
Underground Plbg. Test
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Test
iL
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Jnderground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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A.P.N.: 774-221-011
ADDRESS: 54-210
LEGAL: LOT 01
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PROPERTY LINE 50.9
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UNAUTHORIZED USE WARNING
ARE THE PROPERTY OF
LENOH DESIGN OROUP. REPRODUCTION
N ANY FORM MATHOUT . N CONSENT
j IS EJ(PRESSIY PROHIBITED.
UNAUTHORIZED
USE O(TENDS TO ORIGINAL PIVD MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNINTENTIONAL
C) INFRINGEMENTS.
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A.P.N.: 774-221-011
ADDRESS: 54-210
LEGAL: LOT 01
SANTA I
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. BLOCK 6787,
ARMELITA @ VALE LA QUWTA
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UNAUTHORIZED USE WARNING
ARE THE PROPERTY OF
LENOH DESIGN OROUP. REPRODUCTION
N ANY FORM MATHOUT . N CONSENT
j IS EJ(PRESSIY PROHIBITED.
UNAUTHORIZED
USE O(TENDS TO ORIGINAL PIVD MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNINTENTIONAL
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SCALE
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PLANS PREPARED BY:
LENDEL VENTURES, INC.
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LENCH DESIGN GROUP
A.P. LENCII B
PRESIDENT
A.P.N.: 774-221-011
ADDRESS: 54-210
LEGAL: LOT 01
SANTA I
EISENHOWER DR.
. BLOCK 6787,
ARMELITA @ VALE LA QUWTA
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DATE
07-24-02
SCALE
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PLANS PREPARED BY:
LENDEL VENTURES, INC.
dba
LENCH DESIGN GROUP
A.P. LENCII B
PRESIDENT
FINISH SALT
WATER LINE
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6'-0" 6'-11" 6'-0"
18'-11'•
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SCALE: NONE
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BOND
SPA DETAIL
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SCALE: NONE
A.P.N.: 774-221-011
ADDRESS: 54-210 EISENHOWER DR.
LEGAL: LOT u14 , BLOCK u297,
SANTA CARMELITA @ VALE LA QUINTA
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UNAUTHORIZED USE WARNING !
THESE DESIGNS E THE PROPERTY OF
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GROUP. REPRODUCTION
N ANY FORM WITHOUT VVRITM CONSENT:
IS EXPRESSLY PROHIBITED. UNAUD-IORZED i
USE EXTENDS TO ORIGNAL AND MODIFIED I
DERNATNE PUNS AND IS APPLICABLE TO
INTENTIONAL AND LNNTE4f1OUL
INFRINGEMENTS.
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6'-0" 6'-11" 6'-0"
18'-11'•
1 LONGITUDINAL SECTION
SCALE: NONE
I 12" RA
BOND
SPA DETAIL
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SCALE: NONE
A.P.N.: 774-221-011
ADDRESS: 54-210 EISENHOWER DR.
LEGAL: LOT u14 , BLOCK u297,
SANTA CARMELITA @ VALE LA QUINTA
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UNAUTHORIZED USE WARNING !
THESE DESIGNS E THE PROPERTY OF
LENCN
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GROUP. REPRODUCTION
N ANY FORM WITHOUT VVRITM CONSENT:
IS EXPRESSLY PROHIBITED. UNAUD-IORZED i
USE EXTENDS TO ORIGNAL AND MODIFIED I
DERNATNE PUNS AND IS APPLICABLE TO
INTENTIONAL AND LNNTE4f1OUL
INFRINGEMENTS.
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